Vulval disorders are common complaints that many women will experience at least once in their lifetime. Patients will usually attend their general practitioner. An accurate diagnosis relies on a thorough history and examination. A vulval biopsy may be useful where there is any diagnostic uncertainty. Whilst most cases are straightforward many patients resistant to basic treatment require referral to a vulval service in secondary level care.

Substance misuse is commonplace in general practice patients. Many GPs already see patients with alcohol, heroin and crack cocaine problems. However, the world of drugs is changing due to availability of designer drugs and drugs over the Internet. General Practitioners need to be aware of the importance of drugs and alcohol in producing and exacerbating physical and psychiatric medical symptoms.

Osteoporosis is an increasingly common condition, with decreased bone strength leading to increased risk of fracture. Fragility fractures lead to increased morbidity and mortality, and considerable socioeconomic costs. Identification of patients with osteoporosis can be improved with new fracture risk assessment tools, so that the effective treatments now available can be targeted at those likely to benefit.

Lower urinary tract symptoms (LUTS) are extremely common as men get older. LUTS are bladder storage and voiding symptoms, which are often caused by benign enlargement of the prostate. Initial assessment, investigation and treatment of LUTS can be provided by primary care and will be explored in this article.

Falls are a major cause of injury and death in older people, affecting more than a third of all older people each year, half of whom have recurrent falls. Falls have a major impact on primary and secondary care services and are an important cause of carer strain and admission to long term care. 50% of all care home residents have a fall each year. Multifactorial falls risk assessments should be offered to people who fall. Multifactorial interventions delivered to people who fall are effective in reducing falls rates by up to 25%.

Domestic violence and abuse is a major public health and clinical problem. NICE is planning to publish guidance on domestic violence in 2014. This article defines domestic violence and abuse, examining its prevalence and health impact. It considers why and how primary care should rise to the challenge of responding to domestic violence and abuse.

Europe and the NHS are always near the top of the media agenda, usually to report negatives. The little Englander mentality has gripped some sections of the community who are keen to leave the EU and, subsequently, still envisage UK sitting at all the top tables for decision making. In psychiatric terms this is termed “Delusional”. This is an oft state of consciousness in many of our political masters. Additionally, austerity is effecting us all but it would be worse if UK was not part of the EU and as we come out of this present blight being part of the EU will allow us access to a market of some 450 million people!

This storm in the chattering classes has deflected the government from its core goal; to get the economy back on track and concentrate on other issues not least the near collapse of A&E services coupled with making the recent NHS reforms work. The former has been a direct result of the GP contract negotiated by the previous administration permitting doctors to opt out of out of hours. It will be interesting to see how this is tackled without major sweeteners to the medical profession!

The reforms, which in part were very sensible, are being thwarted of by the lack of succession planning of the move from PCTs to CCGs in all departments from finance, procurement to IT. I have had several SMEs complaining bitterly of the lack of coherence in procurement which allows much larger companies to succeed in contractual tenders. There is a serious risk of the NHS monopoly turning into a beast resembling a duopoly or triopoly. This needs addressing as the whole procurement process, and the reforms, will otherwise fall into rapid disrepute.

One issue is that the present cutbacks have had a detrimental and significant effect on the services providing support for people suffering domestic violence. So many times one hears about, “not joining up the dots”, which has resulted in major incidences, including murder. Sohal and Feder have provided an excellent overview of this “Unacceptable and under recognised problem in primary care”.

The “Falls agenda”, which was a laudable approach to prevent major morbidity in the elderly has worked well but there is still considerable room for further gains. Ali and Conroy give us a timely reminder of those small steps that can accumulate in major cost savings in this area not to mention improved outcomes.Human longevity has its bonuses but the drawbacks may be considerable. Lower urinary tract symptoms, of infrequent occurrence 70 years ago, are now common in males. Ayres and Anderson demystify the problem. Demineralisation leading to osteoporosis is a major concern, mainly in postmenopausal women, but can also afflict the older man. Coupled with falls this is a dangerous mix. An update to manage its increasing prevalence is provided by Batten and Isaacs.

Critchlow and Gail assist us in identifying those who may be involved in substance misuse. This problem should, in the main, be picked up in primary care, but how? Read on. Meanwhile Nunns and Grant have produced an elegant summary, with plenty of illustrations, of “Vulval disorders” which present to GPs.

As always correspondence on the content and suggestions for future features are most welcome. Please email me at the address shown. Happy educational reading and do try out the “Verifiable CPD” at the end of most articles. This is going to be a core requirement in revalidation.